Health organizations require healthcare providers to submit measures of the provider's performance for various reasons. One reason includes tracking provider performance measures over time to ensure quality care is provided. Another reason includes ensuring that providers meet any requirements to receive funds (e.g., grants, reimbursement, incentives, etc.). Regardless of the reasons, the known reporting systems are difficult to use and are highly inefficient.
Others have put forth effort toward coordinating communications among healthcare entities. For example, the following reference describe various aspects of healthcare quality management:
U.S. patent application publication to Wang titled “Systems and Method for Real Time Regional Feedback”, filed Jan. 30, 2006, describes a system that provides for monitoring of healthcare quality measures across organization boundaries. The contemplated system allows organizations to align themselves with the industries leading performers.
U.S. patent application publication to Faris et al. titled “Evidence-Based Quality Improvement and Risk Management Solutions Method”, filed Jun. 14, 2005, describes a tool selection system that selects tools to improve quality based on evidence from literature. The selection process can include determining national authoritative healthcare quality measures.
U.S. patent application publication to Moore titled “Management of Health Care Data”, filed Feb. 1, 2006, provides for systems and methods of syndicating healthcare data among collaborators.
U.S. patent application publication to Wennberg titled “Systems and Methods for Analysis of Healthcare Provider Performance”, filed Oct. 3, 2006, discusses using healthcare measures, both expected and actual, to determine if some services are unwarranted.
U.S. patent application publication to Friedlander et al. titled “System and Method for Quality Control in Healthcare Settings to Continuously Monitor Outcomes and Undesirable Outcomes such as Infections, Re-Operations, Excess Mortality, and Readmissions”, filed Apr. 27, 2007, describes a probability analysis system that can be used within a healthcare quality measure environment.
U.S. patent application publication to Baker et al. titled “Rules-Based Software and Methods for Health Care Measurement Applications and Uses Thereof”, filed Dec. 7, 2007, describes a system that coverts healthcare data into healthcare measures.
One problem with existing systems is that they fail to account for the expansive number of reporting channels among providers and/or organizations. A provider could engage with five, ten, twenty, or more organizations, while an organization could literally interface with hundreds of providers. The sheer number of engagements and communication channels is overwhelming in such a many-to-many environment. It's no wonder such communication exchanges are prone to data errors.
The issues surrounding many-to-many communication exchanges in the medical field are exacerbated by the myriad of data formats that are required for reporting healthcare quality measures (e.g., metrics). A provider is required to report measures according to five, ten or more different data formats as required by various organizations. This places an undue burden on the providers, especially smaller providers, private practices for example. Of course the reverse is true as well. An organization engages with many different providers where each provider prefers to utilize their own reporting formats.
Another problem is that each organization has proprietary requirements for establishing a measure (e.g., a metric) of performance. A provider could easily be required to submit hundreds, if not thousands of different measures across multiple organizations, where each measure has a complex set of requirements. Providers must spend considerable amounts of time to ensure they are reporting a proper measure to the correct organization.
Yet another problem associated with existing Healthcare Quality Measure (HQM) reporting solutions is that the solutions required a provider to have access to highly skilled computer labor to compile, analyze, and produce measure reports. Known systems require a provider to install and manage highly complex databases, query the databases using arcane SQL statements, and compile reports according to the various formats discussed above. The skills required for such work are often beyond the capability of a provider or beyond a provider's budget for hiring skilled labor. Unfortunately, most providers simply can not provide reports, thereby reducing their chances of obtaining funding, grants, incentives, or other benefits.
The above issues combine to create additional problems, even for those providers that do have access to the necessary skilled labor. The voluminous number of measures coupled with reporting requirements results in the provider lacking sufficient time (1) to compile relevant encounter data from their databases of patient and encounter data, (2) to analyze the compiled data to derive measures, and (3) to provide the results to the various organizations according to preferred formats. Most providers simply like time or resources to report to all desirable organizations in a timely fashion.
Thus there is a still considerable need systems, configurations, or methods for providing healthcare quality measure (HQM) reports that addresses the above issues.